I have always been interested in how mental health is depicted in literature. Shakespeare was brilliant at it, and throughout the history of literature, psychiatric illness has provided rich material for novels and poetry. Some of my favourite novels have mental health as a major theme: Anna Karenina by Leo Tolstoy; Madame Bovary by Gustave Flaubert; The Virgin Suicides by Jeffrey Eugenides; and We Need To Talk About Kevin by Lionel Shriver. It is novels like these that initially inspired me to write my own novel, in which an ‘ordinary’ family is changed forever by mental illness.

In my early psychiatry career, I read Sylvia Plath’s The Bell Jar. It was the first book that I had read that was able to really make me live a patient’s experience of mental illness and treatment. While she wrote this as a novel, it is accepted that much of the story is autobiographical. Infamously, Sylivia Plath died of suicide, after a long struggle with severe mental health issues.

I always remember her description in the novel of receiving ECT (electroconvulsive therapy) as a treatment whilst in a psychiatric hospital:

“Doctor Gordon was fitting two metal plates on either side of my head. He buckled them into place with a strsp that dented my forehead, and gave me a wire to bite.

I shut my eyes.

There was a brief silence, like an indrawn breath.

Then something bent down and took hold of me and shook me like the end of the world. Whee-ee-ee-ee-ee, it shrilled, through an air crackling with blue light, and with each flash a great jolt drubbed me till I thought my bones would break and the sap fly out of me like a split plant.” (p 151)

I was reading Ted Hughes’ book of poetry Birthday Letters yesterday. Ted Hughes, himself a great poet (and poet laureate to Queen Elizabeth), was married to Sylvia Plath, and this book of poems are almost all about his life with her. In one, The Tender Place, he writes about his experience of seeing her having ECT. The poem needs to be read as a whole to appreciate its power, but this excerpt shows how moving it is:

“…Somebody wired you up.

Somebody pushed the lever. They crashed

The thunderbolt into your skull.

In their bleached coats with blenched faces,

They hovered again

To see how you were, in your straps.

Whether your teeth were still whole.

… Terror

Was the cloud of you

Waiting for these lightenings. I saw

An oak limb sheared at a bang.

…

Came up, years later.

Over-exposed, like an X-ray —

Brain-map still dark-patched

With scorched earth scars

Of your retreat…”

Of course, ECT now is done very differently, under general anaesthetic, and with muscle relaxants to stop the physical manifestations of the induced seizures. It is a very effective treatment in the right circumstances and I have seen some extremely sick patients respond amazingly to it. But these descriptions, through the medium of creative writing, describe the base fear and physical horror that a patient and her carer experienced in having this treatment in the 1960s. From what I’ve read, there is no doubt that Sylvia Plath needed this treatment, and it seemed completely appropriate – and worked at the time to improve her mood. But there is something in both her, and Ted Hughes’ use of language that describes it far more effectively than I have ever heard it described before.

In my own novel, one of my characters undergoes a similar treatment. Re-reading these works has reminded myself of why I write, and what I hope to achieve in my own creative writing.